Benign Prostatic Hyperplasia

Benign prostatic hyperplasia, or BPH for short, is the enlargement of the prostate gland. It is caused by excess growth of cells in the prostate. This condition is not the same as prostate cancer.

What is going on in the body?

The prostate is a walnut-sized gland that is part of the male reproductive system. This gland surrounds the urethra, the tube that carries urine from the bladder out of the body. The job of the prostate is to squeeze fluid into semen to help with fertility. The prostate responds to testosterone, the main male hormone. After puberty, it doubles in size. Around age 25, it grows again and continues to grow slowly throughout a man's life. This enlargement does not usually cause problems until later in life. BPH rarely causes symptoms before age 40. But more than half of men in their 60s and up to 90% in their 70s have some symptoms of BPH. In some men, the enlarged prostate can cause a blockage of the bladder outlet known as prostatism. Although the actual causes are more complex, it is helpful to think of BPH as a blockage of urine flow by an enlarging prostate.

What are the causes and risks of the condition?

The cause of BPH is not well understood. Some experts think that factors related to aging and changing hormone levels may spur the development of BPH.

The primary risk of BPH is that urine flow may be blocked. This can sometimes cause kidney damage, bladder stones, and urinary tract infections.

What are the signs and symptoms of the condition?

Symptoms may range from mild to severe, and the most common ones involve changes or problems with urination, such as:

Some men have no symptoms at all before suddenly finding themselves totally unable to urinate. This condition is called acute urinary retention and may be triggered by over-the-counter cold or allergy medicines that contain decongestants.

How is the condition diagnosed?

BPH is commonly diagnosed when its symptoms begin to interfere with daily life, but the doctor may also find an enlarged prostate during a routine checkup. The symptoms of BPH can be very much like those caused by prostate cancer and other serious conditions. So, further testing may be needed. A doctor can use a gloved finger in the rectum to check the prostate size and for small, hard lumps that might suggest prostate cancer. The doctor may also order a prostate-specific antigen, also known as a PSA, blood test. If this value is abnormal, the doctor may next order a biopsy sample of the prostate to look for prostate cancer.

Other tests may be done in certain cases. These may include measuring the rate of urine flow and checking with a catheter or special X-ray test to see how much urine is left in the bladder after voiding. A pressure-flow study combines measuring the urine flow and the pressure in the bladder during voiding. Cystoscopy is a procedure that uses a tiny telescope to look inside the urethra, prostate, and bladder for the amount of blockage. Ultrasound, a type of X-ray test, may be used to measure the exact size of the prostate. This can be important in making choices about therapy. A symptom questionnaire can help to measure both the symptoms and the response to treatment. Although some of the symptoms of BPH and prostate cancer are the same, BPH does not increase the chance of prostate cancer.

What can be done to prevent the condition?

There are no widely accepted ways to prevent BPH.

What are the long-term effects of the condition?

Long-term effects are generally due to chronic, incomplete emptying of the bladder and may include:

What are the risks to others?

BPH is not contagious.

What are the treatments for the condition?

Prostatism is usually treated first with medicines called alpha blockers, such as doxazosin or terazosin. These drugs were first used to treat high blood pressure. Tamsulosin is the first alpha blocker developed specifically for BPH. These drugs relax the muscle in the prostate and at the bladder neck, which allows better urine flow.

The FDA has approved a fourth drug, finasteride, to treat BPH, but its action is different. It works to suppress testosterone, which can shrink the size of the prostate and improve symptoms. Some studies suggest that finasteride can shrink the prostate by about 30%. This may take several months, and often the improvement is not as dramatic as that seen with alpha blockers. But finasteride has been shown to reduce the long-term risk of a complete inability to urinate. And that can result in less need for surgery.

If medicine does not work, or cannot be taken, surgery is an option. The most common operation has been transurethral resection of the prostate, also called TURP. This involves passing a special tiny telescope, called an endoscope, through the urethra. The endoscope has an electrified loop, which is passed into the area of the prostate that surrounds the bladder neck. Under anesthesia, the electrified loop is used to scoop out tissue from the prostate and free the flow of urine. This surgery has a success rate of about 85%.

Because TURP is costly, inconvenient, and invasive, there has been great effort to find other ways that will relieve BPH symptoms. A variety of energy sources have been tried, including high-intensity sound waves, lasers, heat, and radio waves. Sometimes tubes called stents are placed in the urethra to hold it open. Some of these procedures require a small amount of anesthesia, and others require none at all. In general, these procedures are less risky than TURP but do not work as well. Many of these techniques are still being perfected.

What are the side effects of the treatments?

Medicines used to treat BPH may all cause side effects, such as dizziness, low blood pressure, and impotence. Specific side effects depend on the drug used.

Dangerous complications after TURP are unusual. The most common side effect of TURP, which occurs in about 4% to 6% of people who have the procedure, is a need to place a urinary catheter for a short time after the operation. Some bleeding is normal after surgery, but it should clear up by the time the person goes home from the hospital. Drinking a lot of water will help flush out the bladder and speed healing. As with any surgery, there may be some temporary discomfort for a few weeks. This will decrease as time goes on.

What happens after treatment for the condition?

Those treated with medicines often need treatment for life or until symptoms get bad enough to require surgery. Most people recover from TURP quickly. Blood in the urine gradually disappears over the first week or so. Symptoms of bladder blockage are usually relieved right away. The degree and speed of return to normal bladder function is often related to the severity of the condition and how long it existed before treatment began. In some cases, a second TURP or other prostate surgery may be needed later.

How is the condition monitored?

Those treated with medicines can often monitor their own symptoms at home. After TURP or prostate surgery, the person is seen from time to time by the healthcare provider and watched for a return of symptoms. Any new or worsening symptoms should be reported to the doctor right away.

Author:Stuart Wolf, MD
Date Written:
Editor:Crist, Gayle P., MS, BA
Edit Date:12/18/01
Reviewer:Melinda Murray Ratini, DO
Date Reviewed:12/18/01